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SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN EXAMINATION 9TH EDITION BY SILVESTRI CHAPTER 1-44

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Prepare for success on the NCLEX-RN® exam with this complete review! Often called the best NCLEX® exam review book ever, Saunders Comprehensive Review for the NCLEX-RN® Examination reviews all nursing content areas related to the current test plan. This new edition includes 5,700 NCLEX exam-styl...

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lOMoARcPSD|27929433




COMPREHENSIVE REVIEW for the



EXAM I NATION
EDITION




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Contents


Unit I Unit IV
NCLEX-RN® Exam Preparation, 1 Growth and Development Across
1 Clinical Judgment and the Next Generation the Life Span, 234
NCLEX (NGN)-RN® Examination, 2 18 Theories of Growth and Development, 236
2 Self-Efcacy and Pathways to Success, 17 19 Growth, Development, and Stages of Life, 244
3 The NCLEX-RN® Examination from a Graduate’s 20 Care of the Older Client, 266
Perspective, 22
4 Clinical Judgment and Test-Taking
Strategies, 24
Unit V
Maternity Nursing, 275
Unit II 21 Reproductive System, 277
22 Prenatal Period, 285
Professional Standards in Nursing, 38 23 Risk Conditions Related to Pregnancy, 300
5 Population Health Nursing, 40 24 Labor and Birth, 323
6 Ethical and Legal Issues, 53 25 Problems with Labor and Birth, 336
7 Prioritizing Client Care: Leadership, Delegation, 26 Postpartum Period, 343
and Emergency Response Planning, 68 27 Postpartum Complications, 350
28 Care of the Newborn, 358
29 Maternity and Newborn Medications, 380
Unit III
Foundations of Care, 85 Unit VI
8 Fluids and Electrolytes, 88
9 Acid-Base Balance, 106 Pediatric Nursing, 391
10 Vital Signs and Laboratory Reference 30 Integumentary Problems, 392
Intervals, 116 31 Hematological Problems, 399
11 Nutrition, 132 32 Oncological Problems, 406
12 Health and Physical Assessment of the Adult 33 Metabolic and Endocrine Problems, 416
Client, 143 34 Gastrointestinal Problems, 425
13 Safety and Infection Control, 166 35 Eye, Ear, and Throat Problems, 444
14 Medication Administration and Intravenous 36 Respiratory Problems, 451
Therapies, 178 37 Cardiovascular Problems, 467
15 Perioperative Nursing Care, 189 38 Renal and Genitourinary Problems, 479
16 Hygiene, Mobility, and Skin Integrity, 204 39 Neurological and Cognitive Problems, 487
17 Urinary and Bowel Elimination, 218 40 Musculoskeletal Problems, 498
41 Immune Problems and Infectious Diseases, 507
42 Pediatric Medication Administration and
Calculations, 520


iii

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iv Contents


Unit VII Unit XIV
Integumentary Problems of the Adult Eye and Ear Problems of the Adult
Client, 527 Client, 821
43 Integumentary Problems, 528 57 Eye and Ear Problems, 822
44 Integumentary Medications, 538 58 Eye and Ear Medications, 842


Unit VIII Unit XV
Oncological and Hematological Neurological Problems of the Adult
Problems of the Adult Client, 547 Client, 852
45 Oncological and Hematological Problems, 549 59 Neurological Problems, 853
46 Oncological and Hematological 60 Neurological Medications, 877
Medications, 587

Unit XVI
Unit IX
Musculoskeletal Problems of the Adult
Endocrine Problems of the Adult Client, 598
47 Endocrine Problems, 599
Client, 888
48 Endocrine Medications, 626 61 Musculoskeletal Problems, 889
62 Musculoskeletal Medications, 910

Unit X
Unit XVII
Gastrointestinal Problems of the Adult
Immune Problems of the Adult
Client, 641
49 Gastrointestinal Problems, 643
Client, 918
50 Gastrointestinal Medications, 671 63 Immune Problems, 919
64 Immune Medications, 933

Unit XI
Unit XVIII
Respiratory Problems of the Adult
Client, 679 Mental Health Problems of the Adult
51 Respiratory Problems, 680 Client, 940
52 Respiratory Medications, 701 65 Foundations of Psychiatric Mental Health
Nursing, 941
66 Mental Health Problems, 954
Unit XII 67 Addictions, 975
68 Crisis Theory and Intervention, 987
Cardiovascular Problems of the Adult 69 Psychotherapeutic Medications, 1001
Client, 719
53 Cardiovascular Problems, 720
54 Cardiovascular Medications, 760
Unit XIX
Complex Care, 1015
Unit XIII 70 Complex Care, 1017

Renal and Urinary Problems of the Adult References, 1088
Index, 1090
Client, 778
55 Renal and Urinary Problems, 779
56 Renal and Urinary Medications, 811

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UNIT I


NCLEX-RN® Exam Preparation






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CHAPTER 1
Preparation




Clinical Judgment and the Next Generation
NCLEX (NGN)-RN® Examination
Linda A. Silvestri, PhD, RN, FAAN
Angela E. Silvestri, PhD, APRN, FNP-BC, CNE




This resource provides you with nursing content
The Pyramid to Success review, including the content identied in the current
Saunders Comprehensive Review for the NCLEX-RN® NCLEX test plan, and practice questions of all types,
Examination each chapter, you will nd Pyramid Point bullets
About This Resource and the NCLEX-RN ®
Examination NCLEX-RN examination and Pyramid Alert bullets
Welcome to the Pyramid to Success and Saunders Com- in red text throughout the chapter that alert you to
prehensive Review for the NCLEX-RN® Examination. This important information about nursing concepts. Each
resource is specially designed to help you begin your chapter includes Clinical Judgment: Cognitive Skill client
successful journey to the peak of the pyramid, becoming scenarios that focus on one of the cognitive skills.
a registered nurse. As you begin your journey, you will The book contains 854 NCLEX-style questions. The
be introduced to all of the important points regarding Evolve site accompanying this book contains all of the
the NCLEX-RN examination and the process of testing, questions from the book plus additional Evolve ques-
and to unique and special tips regarding how to prepare tions for a total of more than 6,000 practice questions.
yourself for this important examination, both academi- The types of practice questions include multiple choice;
cally and nonacademically. You will read what a nursing ll-in-the-blank; multiple-response (select all that
graduate who recently passed the NCLEX-RN exami- apply); ordered-response; questions that contain a g-
nation has to say about the test. Important test-taking ure, chart/exhibit, or a graphic option item; and audio
strategies are detailed. These details will guide you in item formats. Examples of some question types can be
selecting the correct option or assist you in making an located throughout this chapter. In addition, the NGN
educated guess if you are not entirely sure about the cor- item types are provided on the accompanying Evolve
rect answer; they will also guide you in ways to answer site.
the NGN test items. Each unit in this book begins with As you read each chapter, identify your strengths and
the Pyramid to Success. The Pyramid to Success addresses areas that are in need of further review.
specic points related to the NCLEX-RN examination. Test your strengths and abilities by answering all
Client Needs and activities as identied in the test plan practice questions provided in this book and on the
framework for the examination are listed, as are learn- accompanying Evolve site. Be sure to read all rationales
ing outcomes and competencies for the unit. Cognitive and test-taking strategies. The rationale provides you
Skills identied in the National Council of State Boards with signicant information regarding the correct and
of Nursing (NCSBN) Clinical Judgment Measurement incorrect options. The test-taking strategy provides you
Model (NCJMM) are a focus in chapters and practice with the logical path to selecting the correct option. A
questions. Pyramid Terms are key words that are dened reference source and page number are provided so that
in the glossary on the accompanying Evolve site and set you can easily nd information you need to review in
in a green color throughout each chapter to direct your another Elsevier text. Each practice question on the
 attention to signicant points for the examination. accompanying Evolve site is coded on the basis of the


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CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 3


Level of Cognitive Ability, the Client Needs category,
TABLE 1.1 Cognitive Skills/Processes and Descriptions
Clinical Judgment/Cognitive Skill, the Integrated Pro-
cess, the Content Area, the Health Problem if applica- Cognitive Skill/Process Description
ble, and Priority Concepts. The Health Problem code is Recognize cues Identifying signicant data; data can be
a unique and helpful feature that allows you to lter and from many sources (assessment)
select questions based on a disease process when you Analyze cues Connecting data to the client's clinical
are practicing questions on Evolve. For example, if heart presentation—determining if the data is
failure is your area of interest, you can select “Adult expected? Unexpected? (analysis)
Health, Cardiovascular, Heart Failure” on the Evolve Prioritize hypotheses Ranking hypotheses; what are the
site, and all questions on this content will be gener- concerns or client needs/problems and
ated for practice. In addition, two Priority Concepts that their priority? (analysis)
relate to the content of the question are identied. This Generate solutions Using hypotheses or client needs to
code is especially helpful for students whose curriculum determine interventions for an expected
is concept-based. Additionally, information about all outcome (planning)
of the special features of this resource and the question Take action Implementing the generated solutions
types is located in the preface of this book. addressing the highest priorities or
hypotheses (implementation)
Other Resources in the Saunders Pyramid to Success Evaluate outcomes Comparing observed outcomes with
There are several other resources in the Saunders Pyra- expected ones (evaluation)
mid to Success program. These include the following:
From Dickison, P., Haerling, K.A., & Lasater, K. (2019). Integrating the
The Saunders Q&A Review for the NCLEX-RN® Examina- National Council of State Boards of Nursing Clinical Judgment Model
tion, The HESI/Saunders Online Review for the NCLEX-RN® into Nursing Educational Frameworks. Journal of Nursing Education,
Examination, Saunders Clinical Judgment and Test-Taking 58(2), 72–78.
Strategies: Passing Nursing School and the NCLEX® Exam,
Strategies for Student Success on the Next Generation
NCLEX® (NGN) Test Items, Saunders Q&A Review Cards analyzing cues; (3) prioritizing hypotheses; (4) gener-
for the NCLEX-RN® Exam, and Saunders RNtertainment ating solutions; (5) taking action; and (6) evaluating
for the NCLEX-RN® Exam. The HESI® CompassTM Course outcomes (Dickison et al., 2019). Table 1.1 provides a
is also a resource for NCLEX preparation and provides description of these six cognitive skills/processes identi-
you with an individual coach to guide you in your prep- ed in the NCJMM. The NCJMM also serves as a guide
aration. Ask your nursing instructors about institutional for the NCSBN to create NGN® questions. The NCJMM
access to this course. continues to evolve as may the NGN® item types that
The resources in the Saunders Pyramid to Success will be presented in the exam. All of the current NCLEX
are described in the preface of this book and can be item types known as stand-alone items, the new clinical
obtained online by visiting elsevierhealth.com or by judgment stand-alone items (bow-tie and trend), and
calling 800-545-2522. unfolding case studies that include six NGN items will
Let’s begin our journey through the Pyramid to be presented in the NGN. Some of these new NGN®
Success. item types can be found on the Evolve site accompany-
ing this book, and an example of a highlight-in-table
NGN item can be located in Chapter 4, Box 4.5. The
Clinical Judgment and Next Generation NCSBN conducts ongoing research on the NGN test
NCLEX® Items design and NGN items. The information in this chapter
reects what is currently published by the NCSBN. The
Clinical judgment is the observed outcome of critical NGN will be implemented in April 2023 and because
thinking and decision-making (Dickison, Haerling, some additional changes in item types may occur, we
& Lasater, 2019). In recent years, heightened atten- encourage you to frequently access the NCSBN website
tion has been paid to clinical judgment as a means of at www.ncsbn.org for updates about the NGN design,
teaching, learning, and assessment and testing. The items, and test plan updates.
Next Generation NCLEX-RN® examination requires
candidates to demonstrate a higher level of ability in
applying clinical judgment in the delivery of client care. Examination Process
Clinical judgment can also be used as a test-taking strat-
egy to answer test questions (refer to Chapter 4). The An important step in the Pyramid to Success is to
National Council of State Boards of Nursing (NCSBN) become as familiar as possible with the examination
has created a Clinical Judgment Measurement Model process. Candidates facing the challenge of this exami-
(NCJMM) that consists of applying six cognitive skills nation can experience signicant anxiety. Knowing what
or processes. These include: (1) recognizing cues; (2) the examination is all about and knowing what you will


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4 UNIT I NCLEX-RN® Exam Preparation


encounter during the process of testing will assist in online tutorial when you are preparing for the NCLEX
alleviating fear and anxiety. The information contained examination. The tutorial will instruct you on the use of
in this chapter was obtained from the NCSBN website the on-screen optional calculator, the use of the mouse,
(www.ncsbn.org) and from the current NCSBN test and how to record an answer. The tutorial also provides
Preparation




plan for the NCLEX-RN and includes some procedures instructions on how to respond to the different ques-
related to registering for the exam, testing procedures, tion types on this examination. NCSBN also provides
and the answers to the questions most commonly asked an online tutorial about the new item types that allows
by nursing students and graduates preparing to take the you to interact with these items as much as you need to
NCLEX. You can obtain additional information regard- before taking the exam. In addition, at the testing site,
ing the test and its development by accessing the NCSBN a test administrator is present to assist in explaining the
website and clicking on the NCLEX Examination tab or use of the computer to ensure your full understanding
by writing to the National Council of State Boards of of how to proceed.
Nursing, 111 East Wacker Drive, Suite 2900, Chicago, IL
60601. You are encouraged to access the NCSBN web- The new NGN item types will not be scored as either
site, because this site provides you with the most up- all correct or all incorrect. Instead, new scoring models
to-date and valuable information about the NCLEX and will be applied for new NGN items that allow partial
other resources available to an NCLEX candidate. You credit scoring for most items. For specic information
are also encouraged to access the most up-to-date Can- on the scoring models, refer to the NCSBN website at
didate Bulletin. This document provides you with every- www.ncsbn.org and the National Council of State Boards
thing you need to know about registration procedures of Nursing’s Next Generation NCLEX News (2021) at
and scheduling a test date. https://www.ncsbn.org/NGN_Summer21_Eng.pdf.



Computer Adaptive Testing
Development of the Test Plan
The acronym CAT stands for computer adaptive test. The
exam is delivered as a variable length CAT, which allows The test plan for the NCLEX-RN examination is devel-
for the exam to select stand-alone items and item sets oped by the NCSBN. The examination is a national
(unfolding case studies) that are optimal for each test- examination; the NCSBN considers the legal scope of
taker. The stand-alone items are selected and balanced nursing practice as governed by state laws and regula-
on the basis of the percentages of each of the test plan tions, including the nurse practice act, and uses these
categories and subcategories. Each item is selected to laws to dene the areas on the examination that will
target the candidate’s ability level. Once all test plan assess the competence of the test-taker for licensure.
requirements are met, a stopping rule is triggered in The NCSBN also conducts an important study every
which a reliable pass-or-fail decision is made. 3 years, known as a practice analysis study, to link the
When taking a CAT, once an answer is recorded, examination to nursing practice. The results of this
all subsequent questions administered depend, to an study determine the framework for the test plan for
extent, on the answer selected for that question. Skip- the examination. The participants in this study include
ping questions or returning to earlier questions is newly licensed registered nurses from all types of gen-
incompatible with the logical methodology of a CAT. eralist nursing education programs. Participants of this
The inability to skip questions or go back to change pre- study provide valuable information about work settings.
vious answers will not be a disadvantage to you; you will From a list of nursing care activities (activity statements)
not fall into that “trap” of changing a correct answer to provided, the participants are asked about the applica-
an incorrect one with the CAT system. bility, frequency, and importance of performing these
If you are faced with a question that contains unfa- activities in relation to client safety. A panel of content
miliar content, you may need to guess at the answer. experts at the NCSBN analyzes the results of the study
There is no penalty for guessing, but you need to make and makes decisions regarding the test plan framework.
an educated guess. With most of the questions, the The NCSBN also conducted extensive research and
answer will be right there in front of you. If you need to experimentation and sought out subject matter expert
guess, use your nursing knowledge and clinical experi- feedback from educators, researchers, and practicing clin-
ences and clinical judgment skills to their fullest extent ical nurses about clinical experiences and health prob-
and all of the test-taking strategies you have practiced in lems commonly encountered by a new graduate nurse.
this review program. Findings supported the need for developing a model for
You do not need any computer experience to take measuring clinical judgment in the test plan design. This
this examination. A keyboard tutorial is provided on led to the development of new NGN test items and con-
the NCSBN website, and you are encouraged to view the tinuous research to test item reliability and validity.



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CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 5


Test Plan TABLE 1.2 Levels of Cognitive Ability: Level and
Descriptions and Examples
The questions are written to address Level of Cognitive Level Description and Example
Ability, Client Needs, and Integrated Processes, includ-
Remembering Recalling, retrieving information from memoriza-
ing Clinical Judgment and Cognitive Skills, as identied tion, previous learning, or long-term memory.
in the test plan developed by the NCSBN. Example: A normal blood glucose level is 70-99
mg/dL (3.9-5.5 mmol/L).
The content of the NCLEX-RN examination reects Understanding Determining the meaning of information.
the activities identied in the practice analysis study Example: A blood glucose level of 60 mg/dL (3.34
conducted by the NCSBN. Exam items are written based mmol/L) is lower than the normal reference range.
on the test plan framework and these activities rather Applying Carrying out an appropriate action based on
than on content areas such as adult health, maternity, information.
pediatrics, or mental health. Example: Administering 10–15 g of carbohydrate
such as a ½ glass of fruit juice to treat mild hypo-
glycemia.
Level of Cognitive Ability Analyzing Examining concepts or data and interpreting how
Levels of cognitive ability include remembering, under- the concepts or data connect or relate to one
standing, applying, analyzing, evaluating, and creating. another.
Example: The concept is mild hypoglycemia and
The practice of nursing requires complex thought pro- the connecting data are the signs and symptoms
cessing and critical thinking in decision making and of mild hypoglycemia, such as hunger, irritability,
in making clinical judgments. Therefore, you will not weakness, headache, blood glucose level lower
encounter any remembering or understanding questions than 60 mg/dL (3.34 mmol/L).
on the NCLEX. Questions on this examination are writ- Evaluating Making judgments, conclusions, or validations
ten at the applying level or higher in terms of cognitive based on evidence.
ability. Table 1.2 provides descriptions and examples of Example: Determining that treatment for mild
hypoglycemia was eective if the blood glucose level
each level of cognitive ability. Box 1.1 presents an exam-
returned to a normal level between 70-99 mg/dL
ple of a question that requires you to apply data. (3.9-5.5 mmol/L) and signs and symptoms resolved.

Client Needs Creating Generating or producing a new outcome or plan of
care by putting parts of information together.
The NCSBN identies a test plan framework based on Example: Designing a safe and individualized plan
Client Needs, which includes four major categories. of care with the interprofessional health care team
Some of these categories are divided further into sub- for a client with diabetes mellitus that meets the
categories. The Client Needs categories are Safe and client’s physiological, psychosocial, and health
maintenance needs.
Effective Care Environment, Health Promotion and
Maintenance, Psychosocial Integrity, and Physiological Adapted from Understanding Bloom’s (and Anderson and Krathwohl’s)
Integrity (Table 1.3). Taxonomy, 2015, ProEdit, Inc. http://www.proedit.com/understanding-
blooms-and-anderson-and-krathwohls-taxonomy/
Safe and Effective Care Environment
The Safe and Effective Care Environment category
includes two subcategories: Management of Care, category also addresses content required to assist the
and Safety and Infection Control. According to the individual to prevent health problems; to recognize
NCSBN, Management of Care addresses prioritizing alterations in health; and to develop health practices
care and providing and directing nursing care that that promote and support optimal wellness. See Box
will ensure a safe care delivery setting to protect cli- 1.3 for an example of a question in this Client Needs
ents and health care personnel. The NCSBN indicates category.
that Safety and Infection Control addresses content
that will protect clients and health care personnel Psychosocial Integrity
from health and environmental hazards within health The Psychosocial Integrity category addresses content
care facilities and in community settings. Box 1.2 required to promote and support the ability of the cli-
presents examples of questions that address these two ent to cope, adapt, and problem-solve during stressful
subcategories. events. The NCSBN also indicates that this Client Needs
category addresses the emotional, mental, and social
Health Promotion and Maintenance well-being of the client experiencing stressful events and
The Health Promotion and Maintenance category care for the client with an acute or chronic mental ill-
addresses the principles related to growth and devel- ness. See Box 1.4 for an example of a question in this
opment. According to the NCSBN, this Client Needs Client Needs category.



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6 UNIT I NCLEX-RN® Exam Preparation


BOX 1.1 Level of Cognitive Ability: Applying BOX 1.2 Safe and Effective Care Environment
The nurse notes blanching, coolness, and edema at the Management of Care
peripheral intravenous (IV) site. On the basis of these nd- The nurse has received the client assignment for the day.
Preparation




ings, the nurse would implement which action rst? Which client would the nurse assess first?
1. Remove the IV.
2. Apply a warm compress. 1. The client who has a nasogastric tube attached to inter-
3. Check for a blood return. mittent suction
4. Measure the area of inltration. 2. The client who needs to receive subcutaneous insulin
before breakfast
Answer: 1 3. The client who is 2 days postoperative and is complain-
This question requires that you focus on the data in the ques- ing of incisional pain
tion and analyze that data to determine that the client is expe- 4. The client who has a blood glucose level of 50 mg/dL
riencing an inltration. Note the strategic word, rst. Next, you (2.8 mmol/L) and complains of blurred vision
need to consider the harmful effects of inltration and deter-
mine the action to implement rst. Because inltration can Answer: 4
be damaging to the surrounding tissue, the appropriate rst This question addresses the subcategory Management of
action is to remove the IV to prevent further damage. Once Care in the Client Needs category Safe and Effective Care
the IV is removed, further action would be taken, depend- Environment. Note the strategic word, rst, so you need to
ing on the medication infusing at the time of inltration and establish priorities by comparing the needs of each client and
based on agency protocol. Further action may include aspira- deciding which need is urgent. The client described in the
tion of the uid from the site, injection of an antidote, applica- correct option has a low blood glucose level and symptoms
tion of warm or cool compresses for specied time intervals, reective of hypoglycemia. This client should be assessed rst
or elevation of the extremity. so that treatment can be implemented. Although the clients in
options 1, 2, and 3 have needs that require assessment, their
assessments can wait until the client in the correct option is
stabilized.

TABLE 1.3 The Client Needs Categories and Safety and Infection Control
Subcategories and Percentage of Questions on the The nurse prepares to care for a client on contact precau-
NCLEX-RN Examination tions who has a hospital-acquired infection caused by
methicillin-resistant Staphylococcus aureus (MRSA). The
Percentage of client has an abdominal wound that requires irrigation
Client Needs Category and Subcategory Questions
and has a tracheostomy attached to a mechanical ventila-
Safe and Eective Care Environment tor, which requires frequent suctioning. The nurse would
Management of Care 17-23 assemble which necessary protective items before entering
the client’s room?
Safety and Infection Control 9-15
1. Gloves and gown
Health Promotion and Maintenance 6-12 2. Gloves and face shield
3. Gloves, gown, and face shield
Psychosocial Integrity 6-12 4. Gloves, gown, and shoe protectors
Answer: 3
This question addresses the subcategory Safety and Infec-
Physiological Integrity
tion Control in the Client Needs category Safe and Effective
Basic Care and Comfort 6-12 Care Environment. It addresses content related to protecting
Pharmacological and Parenteral Therapies 12-18 oneself from contracting an infection and requires that you
consider the methods of possible transmission of infection,
Reduction of Risk Potential 9-15 based on the client’s condition. Note the data in the ques-
Physiological Adaptation 11-17 tion. Because of the potential for splashes of infective mate-
rial occurring during the wound irrigation or suctioning of the
From National Council of State Boards of Nursing: 2019 NCLEX-RN® tracheostomy, option 3 is correct.
examination: Test plan for the National Council Licensure Examination for
Registered Nurses. Chicago, 2018, National Council of State Boards of
Nursing.
these subcategories as follows: Basic Care and Comfort
addresses content for providing comfort and assistance
to the client in the performance of activities of daily liv-
Physiological Integrity ing. Pharmacological and Parenteral Therapies addresses
The Physiological Integrity category includes four sub- content for administering medications and parenteral
categories: Basic Care and Comfort, Pharmacological therapies, such as intravenous therapies and parenteral
and Parenteral Therapies, Reduction of Risk Potential, nutrition, and administering blood and blood prod-
and Physiological Adaptation. The NCSBN describes ucts. Reduction of Risk Potential addresses content for

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CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 7


BOX 1.3 Health Promotion and Maintenance BOX 1.4 Psychosocial Integrity
The nurse is choosing age-appropriate toys for a toddler. A client with end-stage chronic obstructive pulmonary disease
Which toy is the best choice for this age? has selected guided imagery to help cope with psychological
stress. Which client statement indicates the best understand-
1. Puzzle
ing of this stress-reduction measure?
2. Toy soldiers
3. Large stacking blocks 1. “This will help only if I play music at the same time.”
4. A card game with large pictures 2. “This will work for me if I am alone in a quiet area.”
3. “I need to do this when I lie down in case I fall asleep.”
Answer: 3
4. “The best thing about this is that I can use it anywhere,
This question addresses the Client Needs category Health
anytime.”
Promotion and Maintenance and specically relates to the
principles of growth and development of a toddler. Note the Answer: 4
strategic word, best. Toddlers like to master activities inde- This question addresses the Client Needs category Psychoso-
pendently, such as stacking blocks. Because toddlers do not cial Integrity, and the content addresses coping mechanisms.
have the developmental ability to determine what could be Note the strategic word, best. Focus on the subject, a charac-
harmful, toys that are safe need to be provided. A puzzle and teristic of guided imagery. Guided imagery involves the client
toy soldiers provide objects that can be placed in the mouth creating an image in the mind, concentrating on the image,
and may be harmful for a toddler. A card game with large pic- and gradually becoming less aware of the offending stimulus.
tures may require cooperative play, which is more appropriate It can be done anytime and anywhere; some clients may use
for a school-age child. other relaxation techniques or play music with it.



preventing complications or health problems related to as stand-alone items and unfolding case studies. The
the client’s condition or any prescribed treatments or stand-alone items will be accompanied by a question that
procedures. Physiological Adaptation addresses content tests more than one cognitive skill. Each unfolding case
for managing and providing care to clients with acute, study will be accompanied by six NGN item type ques-
chronic, or life-threatening conditions. See Box 1.5 for tions, and each cognitive skill will be tested. Every can-
examples of questions in this Client Needs category. didate will be administered three unfolding case studies,
each with six accompanying items. These three unfold-
Integrated Processes ing case studies will be administered within the rst 85
The NCSBN identies ve processes in the test plan that questions on the exam (minimum length exam). After
are fundamental to the practice of nursing. These pro- the minimum-length exam, if a stopping rule is not trig-
cesses are incorporated throughout the major categories gered, then the exam will continue and stand-alone items
of Client Needs. The Integrated Process subcategories are (bow-tie and trend) will be administered as part of the
Caring, Communication and Documentation, Nursing exam. Examples of both stand-alone items and unfold-
Process (Assessment, Analysis, Planning, Implementa- ing case studies and NGN items can be located on the
tion, and Evaluation), Culture and Spirituality, and Teach- Evolve site accompanying this book. These are specially
ing and Learning. See Box 1.6 for an example of a question designed to simulate the NCLEX experience of testing for
that incorporates the Integrated Process of Caring. these NGN item types. Both NGN stand-alone items (cur-
rently known as bow-tie and trend) and unfolding cases
with accompanying NGN items are included. Refer to the
Types of Questions on the Examination Evolve site for practice with these question types. Addi-
and Scoring tionally, the unique test-taking strategies used to answer
NGN items are illustrated with each bow-tie and trend
The types of questions on the current NCLEX include item and with items accompanying the unfolding case
multiple-choice; ll-in-the-blank; multiple-response; studies. Chapter 4, Box 4.5 provides an example of one
ordered-response (prioritizing); image (hot spot) ques- type of NGN question and its unique test-taking strategy.
tions; gure, chart/exhibit, or graphic option items; and In addition to the stand-alone items (bow-tie and
audio formats. These question types will continue to trend), according to the NCSBN, other NGN item types
be a part of the NCLEX examination, and each of these will be used. Table 1.4 provides a list of the NGN ques-
question types will be scored as either correct or incor- tion types. The NCSBN also identies three scoring
rect, known as dichotomous scoring. Currently, no partial methods for NGN items. These scoring methods are
credit is given. Thus, the possible points for these ques- described in Table 1.5
tion types will be 0 or 1 point. Examples of these ques- The NCSBN provides specic directions for you to
tion types follow. follow with all question types on the NCLEX to guide
The NGN question types will also be on the exam, you through the testing process. Be sure to read these
starting in April 2023, and will use a case study approach directions as they appear on the computer screen.


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